Visual Improvement After Secondary Retropupillary Iris-Claw IOL in Pediatric Ocular Trauma

Abstract

Introduction Penetrating ocular trauma in children can affect the cornea, iris, and lens, causing corneal laceration, lens displacement, and traumatic cataract, requiring prompt surgical intervention [1,2]. Surgical wound repair and lensectomy with partial vitrectomy followed by appropriate postoperative care, including possible secondary intraocular lens (IOL) implantation, can achieve favorable visual outcomes while monitoring for amblyopia, strabismus, macular edema, glaucoma and other complications [1–3]. Case Presentation A 10-year-old sustained a right-eye injury from a tile fragment, causing full-thickness corneal wound with iris prolapse, hyphema, and lens displacement. Corneal repair, lensectomy, and partial vitrectomy were performed, followed by topical and systemic therapy. After corneal sutures removal, a prescribed contact lens for aphakia was poorly tolerated (visual acuity 0.01; best-corrected visual acuity (BCVA) 0.7) and right-eye exotropia was noted. One month later, a retropupillary Artisan IOL was implanted. Later optical coherence tomography revealed postoperative cystoid macular edema which resolved with topical steroid and non-steroidal anti-inflammatory drugs. A few months later, BCVA improved from 0.1 to 0.6 in the right eye; the fellow eye remained 1.0. Discussion Management of pediatric penetrating eye injuries commonly includes lensectomy, partial vitrectomy [4]. When capsular support is absent, iris-claw IOL provide an effective option for visual recovery [5]. However, studies report frequent lensectomy complications such as visual axis opacification, strabismus, and the need for additional procedures, with final visual outcomes often influenced by macular status [4,6]. Therefore, long-term monitoring of inflammation, intraocular pressure, and macular condition is essential [7]. Conclusions This case shows that secondary retropupillary iris-claw IOL implantation can significantly improve vision after pediatric penetrating ocular trauma. Visual acuity increased from 0.1 during aphakia to 0.6 after secondary IOL implantation, while postoperative cystoid macular edema was successfully managed with topical therapy. Long-term follow-up is crucial to detect complications that may affect visual outcome.